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Wound irrigation exposure
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Wound irrigation exposure

I am concerned about the possibility of being exposed to a blood born pathogen.  Last week I was irrigating an abcess (abscess) with dakins solution.  There was an air bubble in the syringe and when I pressed down on the plunger the air was forcefully expelled and fluid sprayed up.  Most of the spray was on my arm, I do not think it got into my eyes or nose because I would think it would burn from the bleach but the more I think about it the more concerned I become.  I wasn't initially concerned about it because I didn't have any open cuts or breaks in my skin and my thoughts were the dakins solution would kill any bacteria or viruses that were present and I would be fine after thoroughly washing my arm but now I worry about the possibility of the spray getting into my nose or eyes. What is the likely hood that I could be exposed to HIV, Hep C, MRSA, VRE, or any other dangerous bacteria or viruses?

Thanks,
MNS
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Avatar_dr_m_tn
Dear MnS,

Contaminated bodily fluid exposures are almost always stressful.

First, let me say that your exposure appears to be very “low risk.” That being said, I cannot give you an exact percentage of risk but I can tell you that the risk for HIV, Hep C, MRSA, VRE is extremely low in the situation that you describe. Regarding the bacterial agents that you mention (MRSA, VRE), if you were exposed to one of these agents, I would expect that you would have signs and symptoms of an infection (erythema [redness] at the site of exposure, fever, chills, etc).

The facts that (1) the skin of your arm had no open cuts, abrasions, or breaks in the skin and that (2) you immediately washed your arm with soap and water is reassuring.

If you did not notice a splash of droplets contacting your eyes, mouth or face, then it is unlikely such a splash occurred. As you mentioned in your posting, Dakins solution contains sodium hypochlorite (bleach) and is basic (versus acidic) and is usually irritating to mucous membranes in the event of an exposure.

Do you have any information about the “source” patient (HIV status, Hep C)?

Nevertheless, based on the facts that you shared with me, I would say your risk is extremely low for exposure to blood borne pathogens.

Final comments:
1. Always wear a face shield and mask when irrigating a wound.
2. If you suspect mucous membrane exposure, irrigate with water copiously immediately after the potential exposure.
3. You might consider contacting your primary health care provider or the provider that provides occupational health for your employer and ask their opinion on your risk and any recommended follow-up.

Helpful links:
http://www.cdc.gov/ncidod/dhqp/bp_hiv_aerosol.html
http://www.cdc.gov/ncidod/dhqp/bp.html
http://www.cdc.gov/niosh/topics/bbp/
http://www.osha.gov/SLTC/bloodbornepathogens/

I hope this was helpful to you.

~ Dr. Parks

This answer is not intended as and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.
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Philip D Parks, MD, MPH, MOccH, F...Blank
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